Use the tabs below to explore the concept of shared leadership; find resources that help doctors with difficult discussions with their patients; view a PowerPoint presentation; and read about the background to the development of the guidance.

What do we mean by leadership?

Being a good doctor means more than simply being a good clinician. Every day, doctors provide leadership to their colleagues, and vision for the organisations in which they work and to the profession as a whole.

The definition of leadership has undergone an evolution in recent years. We recognise that some doctors are formal leaders who are accountable for the performance of their team, department or organisation.

But we think that the responsibility for identifying problems, solving them and implementing the appropriate action is shared by the team as a whole. This is what we mean by shared leadership.

Student B took part in an audit of Accident & Emergency (A&E) waiting times which she did with one of the nurses. She was able to see how each member of the team played a vital role in ensuring all patients were seen quickly, and how the A&E staff tried to identify which patients needed to be prioritised and seen by the most appropriate member of the team.

Postgraduate stage:

Dr H is a trainee in the care of older people. On her ward there are several patients who are medically fit for discharge but, due to their home circumstances, remain in a hospital bed. The ward nursing staff are keen to move these patients on but staff working in the community have assessed the problems and think that solutions may take time to arrange. The clinical case meeting is tense as the inpatient and community staff come into conflict. Dr H takes an informal chairing role and helps the team look at a range of ways to meet the needs of individual patients and their carers through a team effort. She is able to acknowledge the feelings and the good intentions of all concerned, which helps bring the team meeting to a satisfactory conclusion.

Continuing practice stage:

Dr A is a consultant in A&E. He had a complaint from a relative who felt that her mother was ignored because she was ‘old and confused’. She was upset by some remarks she had overhead, which indicated that her mother’s clinical condition was not being taken seriously. Dr A went to visit the family at home and was struck by the difference in the patient, who was dressed in her own clothes and not confused at all. He went back to the department and, with one of his nursing colleagues, was able to review the attitudes of staff to patients who were confused. They worked with the elderly care team in the trust to run workshops and give feedback on practices and policies to significantly improve the experience of the frail and elderly who attended the A&E department.

Now that you have seen these, you can also review other examples that illustrate how leadership is demonstrated within each of the five domains of the Medical Leadership Competency Framework in terms of:

Do you want to know more?

There is a large – and growing – body of resources related to leadership within medicine. Below you can find out more about leadership and how it is relevant to your work as a doctor.

Our own Leadership and management for all doctors sets out the wider management and leadership responsibilities of doctors in the workplace, including in relation to employment issues, teaching and training, planning, using and managing resources, raising and acting on concerns and participating in service improvement and development.

The Medical Leadership Competency Framework (2010), developed by the Academy of Medical Royal Colleges and the NHS Institute for Innovation and Improvement, describes the leadership competences doctors need in order to become more actively involved in the planning, delivery and transformation of health services.

LeAD is a free e-learning resource based on the MLCF to help clinicians develop understanding of their role in contributing to the management and leadership of health care services.

The Faculty of Medical Leadership and Management have developed a comprehensive online collection of resources to help doctors in their day to day leadership roles.

Tools for discussing resource constraints with patients

All doctors must make the care of patients their first concern. However, the treatment options that can be offered to patients are sometimes limited by resource constraints or by the criteria established through local and national policies.

When this is the case, it will be necessary to discuss with patients the options for continuing their care.

In paragraph 85 of Leadership and management for all doctors we say that doctors must be open and honest with patients, and those close to them when appropriate, about the decision-making process and the criteria for setting priorities in individual cases.

We also outline, in paragraph 86, that when issues arise about allocating resources, doctors should try to resolve them by discussing options with their patients, and others as appropriate. Underlying all our guidance in this area is that doctors should be open and honest with patients when resource constraints may affect the treatment options that are available to them.

The Scottish Medicines Consortium (SMC) provides advice to NHS Boards and their Area Drug and Therapeutics Committees (ADTCs) across Scotland about the clinical and cost-effectiveness of all newly licensed medicines, all new formulations of existing medicines and new indications for established products.

The National Prescribing Centre has also produced a range of resources which can help doctors in their discussions with patients, including:

The checklist within the above publication which contains some practical resources to help organisations to put appropriate systems and processes in place for decision-making.

NHS Evidence, another website developed by NICE, holds a range of case studies which highlight initiatives to improve productivity or efficiency in patient care.

Patient decision aids

Patient decision aid’s (PDA’s) are designed to help patients understand the value of treatment options by presenting evidence-based estimates of the benefits and risks. These may be particularly useful when exploring the rationale behind resource decisions.

Individual funding requests

An individual funding request (IFR) is a request to fund the treatment of an individual that falls outside of the range of treatments that have been previously agreed by the Primary Care Trust (PCT). Such decisions are taken on a case by case basis.